When the Patient Can't Afford His Cancer Treatment

One of the leading non-clinical attributes that affect how oncologists decide which therapeutic agent to prescribe over another is patient affordability. As more and more insurance benefit designs shift the costs of treatment to the patient, affordability will continue to grow as a significant factor that contributes to patient adherence.

“I was an oncology social worker for well over 10 years and I found that I was spending most of my time dealing with the patient’s financial distress,” said Daniel Sherman, MA, LPC, a licensed professional counselor. “The number 1 issue was financial.”

To emphasize that point, a recent survey of insured patients who were receiving treatment for breast, lung, or colorectal cancer demonstrated that financial distress and out-of-pocket costs have several consequences for patients: 70% of patients reduced leisure activities, 48% withdrew savings, and 18% sold possessions. This distress also may result in decreased compliance. As many oncologists can attest, the financial distress of cancer care can significantly affect quality of life and treatment compliance.1

Source: Kantar Health, Patient Survey,

Terms such as financial toxicity and financial distress were not part of a typical conversation between oncologist and patient 10 or 15 years ago, said Sherman. But with annual direct costs for cancer care projected to rise from $104 billion in 2006 to over $173 billion in 2020 and beyond, and the increased media attention to the financial burden of cancer care, stakeholders such as oncologists, patients, insurers, and the pharmaceutical industry are looking for ways to ease the financial burden that can accompany a cancer diagnosis.2

Considerations for the Practice

If a practice is considering hiring a financial navigator there are some considerations. “Depending on the size of the practice and number of patients being seen, I would estimate that a full-time financial navigator can see about 800 new cases a year,” said Sherman.

For uninsured patients, navigators can (See Figure)

Facilitate enrollment in health care exchange plans

Help patients enroll in Medicaid/Medi-Cal programs

Apply for social security and disability benefits on behalf of the patient

Identify and aid the patient to apply for free medications

In many cases, according to Sherman, the biggest obstacle is convincing the practice’s management team that adding another full-time employee (FTE) is needed. He emphasizes that for patients, the main concern—after the fear of dying from the disease—is how am I going to pay for this treatment? “I have found that patients are eager to have this conversation,” he continued. “Especially if there are options to minimize their out-of-pocket responsibilities.”

Navigators can also identify external sources to help pay for treatment, including:

Foundations

Pharmaceutical sponsored programs

Local philanthropic organizations

Cancer center’s charity program

Hiring a financial navigator has a distinct effect on other employees within the practice, as well. “For the oncologist, it improves access to care for the patient. The nurses are thrilled because it decreases the patient’s distress. Oncology social workers are thrilled because it limits their case load.”

“I think the oncology community has finally caught up and recognizes this as a problem,” said Sherman. There are a number of financial assistance program options that a navigator can explore with his patient. This includes manufacturer-direct programs and programs that aid the underinsured or uninsured patient. Financial assistance programs are evolving and oncology practices place increasing value on them.

“Using patient assistance programs offered by the drug manufacturer can provide a temporary fix,” said Sherman. In addition to alleviating some financial distress, well-designed manufacturer-direct programs help keep prescriber decisions focused on clinical, rather than financial, considerations. “Another source of assistance are programs sponsored by foundations that can help with the patient’s out-of-pocket responsibilities.” Minimizing practice burden should be a key consideration in structuring program access, information, enrollment, and qualification. Developing strategies to support underinsured patients in the state exchanges will be essential to ensure continued access and adherence for this patient population.